Preventive care delivery to young children with sickle cell disease

Preventive services can reduce the morbidity of sickle cell disease (SCD) in children but are delivered unreliably. We conducted a retrospective cohort study of children aged 2 to 5 years with SCD, evaluating each child for 14 months and expecting that he/she should receive Z75% of days covered by antibiotic prophylaxis, Z1 influenza immunization, and Z1 transcranial Doppler ultrasound (TCD). We used logistic regression to quantify the relationship between ambulatory generalist and hematologist visits and preventive services delivery. Of 266 children meeting the inclusion criteria, 30% consistently filled prophylactic antibiotic prescriptions. Having Z2 generalist, non-well child care visits or Z2 hematologist visits was associated with more reliable antibiotic prophylaxis. Forty-one percent of children received Z1 influenza immunizations. Children with Z2 hematologist visits were most likely to be immunized (62% vs. 35% among children without a hematologist visit). Only 25% of children received Z1 TCD. Children most likely to receive a TCD (42%) were those with Z2 hematologist visits. One in 20 children received all 3 preventive services. Preventive services delivery to young children with SCD was inconsistent but associated with multiple visits to ambulatory providers. Better connecting children with SCD to hematologists and strengthening preventive care delivery by generalists are both essential.